| Rdr Devine, Llc | |
|
6517 Stoney Creek Drive Fort Wayne IN 46825-4409 | |
| (260) 570-4515 | |
| (260) 209-0762 |
| Full Name | Rdr Devine, Llc |
|---|---|
| Speciality | Counselor |
| Location | 6517 Stoney Creek Drive, Fort Wayne, Indiana |
| Authorized Official Name and Position | Renee Devine (OWNER) |
| Authorized Official Contact | 2604525347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rdr Devine, Llc 902 Windsor Lake Dr Fort Wayne IN 46845-2045 Ph: (260) 452-5347 | Rdr Devine, Llc 6517 Stoney Creek Drive Fort Wayne IN 46825-4409 Ph: (260) 570-4515 |
| NPI Number | 1043828411 |
|---|---|
| Provider Enumeration Date | 07/21/2020 |
| Last Update Date | 02/07/2022 |
| Certification Date | 01/28/2022 |
| Medicare PECOS PAC ID | 9931515889 |
|---|---|
| Medicare Enrollment ID | O20210301002799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043828411 | NPI | - | NPPES |
| Provider Name | Linda L Hartley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699707836 PECOS PAC ID: 5890753057 Enrollment ID: I20041221000163 |
| Provider Name | Emily M Liechty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821438003 PECOS PAC ID: 9234432204 Enrollment ID: I20160126000119 |
| Provider Name | Diana Lightfoot |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568838613 PECOS PAC ID: 0648556993 Enrollment ID: I20170420002672 |
| Provider Name | Bree Ricker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508175274 PECOS PAC ID: 2961835988 Enrollment ID: I20191205001699 |
| Provider Name | Jay A Bastian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912363375 PECOS PAC ID: 0840610689 Enrollment ID: I20201020002847 |
| Provider Name | Joshua Ricker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316561947 PECOS PAC ID: 5193130961 Enrollment ID: I20210209002589 |
| Provider Name | Jennifer E Snider |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457938953 PECOS PAC ID: 5597118950 Enrollment ID: I20240201001921 |
| Provider Name | Katie Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023428208 PECOS PAC ID: 1850744129 Enrollment ID: I20240202001179 |
| Provider Name | Leah Villavicencio |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548711294 PECOS PAC ID: 7517310881 Enrollment ID: I20240202001440 |
| Provider Name | Maryellen Weigand |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1073256095 PECOS PAC ID: 6901259282 Enrollment ID: I20240202001836 |
| Provider Name | Renee Devine |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629514849 PECOS PAC ID: 6800200452 Enrollment ID: I20240202002899 |
| Provider Name | Michelle Hively |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649716036 PECOS PAC ID: 8820433618 Enrollment ID: I20240304000254 |
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